Nutrition and Oral Medicine (Nutrition and Health)

Chapter 11 / Diabetes Mellitus 18511 Diabetes MellitusNutrition and Oral Health RelationshipsRiva Touger-Decker, David A. Sirois,and Anthony T. Vernillo1. INTRODUCTIONDiabetes mellitus (DM) is the most common endocrine metabolic disorder and itsdiagnosis is increasing at an alarming rate (1). No definitive cure exists for this disorder,which is the third leading cause of mortality and morbidity in the United States. In 1980,slightly less than 6 million Americans were diagnosed with diabetes. In 2000, this numberdoubled to about 12 million reported cases. Adults age 65 and older account for approx40% of the population with diabetes. In 2002, this number rose to about 13 millionindividuals diagnosed with diabetes, with roughly 5 million individuals with undiagnoseddiabetes (2). This increased incidence is multifactorial in nature: increased screeningefforts, rising rates of obesity, and longer life spans have all contributed to the risingincidence of diabetes in the United States.DM is a pernicious disease. The relative risk for individuals with diabetes acquiringend-stage renal disease is 25 times that of individuals without diabetes. The relative riskfor patients with diabetes having a limb amputated because of diabetic complications ismore than 40 times that of normal. More than 20,000 amputations per year are performedon patients with DM, representing nearly 50% of all nontraumatic amputations. Therelative risk of an individual with diabetes becoming blind is 20 times greater than for otherindividuals (3). Myocardial infarction is 10 times more likely in the patient with DM.The dental professional is in a prime position to improve the detection of undiagnoseddiabetes (approx 25% of patients with diabetes are undiagnosed) and the surveillance ofglycemic control: 70% of all adults visit the dentist at least once a year. Because dietmanagement is the cornerstone of diabetes management, medical nutrition therapy providedby a registered dietitian (RD) is an essential component of effective diabetesmanagement. Effective health care partnerships between dentists, dietitians, and physiciansis the ideal scenario for optimal disease management. The role for each health careprovider is included in the most recent recommendations for diabetes surveillance (Table1). Earlier detection, treatment, and management of diabetes will improve quality of lifeand reduce disease-associated morbidity and mortality.From: Nutrition and Oral MedicineEdited by: R. Touger-Decker, D. A. Sirois, and C. C. Mobley © Humana Press Inc., Totowa, NJ185